Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying the loan/line.

Employment History

Previous Employer

Industry

Years at Previous Employer

Questions

Are there any outstanding judgements against you?

YesNo

Have you been declared bankrupt within the past 10 years?

YesNo

Have you been declared bankrupt within the past 7 years?

YesNo

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

YesNo

Are you party to a lawsuit?

YesNo

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?

YesNo

Are you presently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?

YesNo

Are you obligated to pay alimony, child support, or separate maintenance?

YesNo

Is any part of the down payment borrowed?

YesNo

Are you a co-maker or endorser on a note?

YesNo

Are you a U.S. Citizen?

YesNo

Are you a permanent resident alien?

YesNo

Do you intend to occupy the property as your primary residence?

YesNo

Have you had an ownership interest in the last three years?

YesNo

Notice Of Intent To Apply Jointly

Please indicate what type of application you are applying for

IndividualJoint

*Applicant Initials

*Date
-
-

Please enter Date Month

Please enter Date

Please enter Date Year

*Co-Applicant Initials

*Date
-
-

Please enter Date of Birth Month

Please enter Date of Birth Date

Please enter Date of Birth Year

Disclosures

{If joint application, read singular pronouns in the plural.} I warrant the truth of the information contained in this application and that all statements made in this application are made for the purpose of obtaining the loan applied for. I warrant that the financial obligations I disclosed in this application and in support of this application are complete and that I have no other outstanding financial obligations of any kind, including any guarantor or cosigner liability. Lender, its agents, successors, and assigns, will rely on the information contained in this application, and I have a continuing obligation to amend and supplement the information provided in this application if any of the material facts I represented should change before closing. If I have left any spaces in this application blank, Lender, its agents, successors, and assigns, may assume the information requested is adverse. I authorize Lender, its agents, successors, assigns, and employees, to investigate and verify all information I have provided to Lender, its agents, successors, and assigns. I understand that it is my sole responsibility to determine the tax effects of the loan and acknowledge that Lender, its agents, successors, and assigns, have not provided any tax advice to me. Lender, its agents, successors, and assigns can give information about my loan to credit reporting agencies and others who may properly receive that information. If the Lender approves this application and Lender, its agents, successors, and assigns, are required to report the amount of interest paid on the loan to the Internal Revenue Service. I understand that Lender, its agents, successors ,and assigns, will report using the Social Security Number (tax identification number) shown above. I understand that if the Social Security Number is incorrect, that I may be subject to Internal Revenue Service penalties. I understand Lender, its agents, successors, and assigns, will keep this application whether or not my credit request is approved.

PLEASE READ AND CHECK BOX

I certify that the information provided in this application is true and correct as of the date set forth opposite my signature on this application and acknowledge my understanding that any intentional or negligent misrepresentations of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq., and liability for monetary damages to the Lender, its agents, successors, and assigns, insurers, and any other person who may suffer any loss due to reliance upon any misrepresentation I made in this application or in any other manner.

USA Patriot Act Requires Identity Verification For All New Accounts

Important Information About Procedures For Opening a New Account to help the government fight the funding of tcrrorism and money laundering
activities, federal 1aw requires all financial institutions to obtain, verify, and record
information that identifies eaeh person or legal entity who opens an account.

Your Cooperation is needed when you open a new account or request a loan. You may
be asked more questions to establish and confirm your identity. It may also be required
for you to provide one or more forms of identification.

Government Monitoring System Information

Please complete this section ONLY IF:

You are applying for a Home Equity Fixed Rate Loan for the purpose of purchasing, refinancing or improving a 1-4 family dwelling:
-OR-

You are applying for a Home Equity Line of Credit (HELOC) for the purpose of purchasing or refinancing a Primary Residence.

Government Monitoring Information is requested
by the federal government for certain types of loans
related to a dwelling in order to monitor the lender's
compliance with equal credit opportunity, fair housing,
and home mortgage disclosure laws. You are not
required to furnish this information, but are encouraged
to do so. You may select one or more designations for
'race.' The law provides that a lender may not
discriminate on the basis of this information, or on
whether you choose to furnish it. However, if you choose
not to furnish the information and you have made this
application in person, under federal regulations the
lender is required to note ethnicity, race and sex on the
basis of visual observation or surname. If you do not wish
to furnish the information, please check below.

I'll Answer Government Monitoring System Information Questions

YesNo

Ethnicity

Race

Sex

Do not complete MARITAL STATUS information if credit is applied for is individual unsecured credit unless Applicant resides in a community property state.

Marital Status

Your application is submitted when we provide you with a confirmation number after you click on the "Submit" button. Please print and keep this number for your records.

Instructions

You can add a co-applicant to this application by clicking “Add Applicant” at the bottom of this page, once you have completed entering your personal information.